Opção técnica para pinçamento coronariano temporário em cirurgia de revascularização do miocárdio sem circulação extracorpórea Technical option for temporary coronary clamping in off pump coronary surgery

STUDY POPULATION CHARACTERISTICS Male patient, 58 years old, born in Duque de Caxias, RJ, with hypertension and type II diabetes for 5 years under clinical control, and with recent onset of angina symptoms. Risk stratification performed for coronary artery disease through exercise stress-testing, which proved to be positive for ischemia with low workload. Cinecoronarioangiography was performed. It showed severe lesions in the proximal and middle third of the anterior interventricular branch with a large diagonal branch among the lesions and an obstructed circumflex branch in its middle third without filling by collateral branches. Ventriculography showed moderate anteroapical hypokinesia with mild global dysfunction. Coronary artery bypass grafting was the surgery of choice due to due to the severity and complexity of coronary artery disease in diabetic patients with left ventricular dysfunction. During the performance of preoperative tests, It was verified the presence of changes in serum creatinine (1.7 mg/dL), although the patient maintains good urine output. Transthoracic echocardiography confirmed mild left ventricular dysfunction (LVEF: 0.5).